hu  Z'mel 


THE  MEDICAL  SCHOOL  OF  THE 
UNIVERSITY  OF  MINNESOTA  and 
THE  MAYO  FOUNDATION  FOR 
THE  PROMOTION  OF  MEDICAL 
EDUCATION  AND  RESEARCH 


I.  The  Formal  Statement  of  the  Committee, 
as  published  in  the  Journal  - Lancet, 
March  15,  1915.  By  the  Committee. 


II.  The  Mayo  Foundation  from  the  Stand- 
point of  The  Graduate  School. 


By  Dean  Guy  Stanton  Ford. 


III.  History  of  Negotiations. 

IV.  Precedents  for  Affiliation. 


By  the  Committee. 


Printed  and  distributed  by 


GEORGE  E.  VINCENT  E.  P.  LYON  J.  E.  MOORE 
J.  C.  LITZENBERG  R.  O.  BEARD 

Committee  upon  The  Relations  of  The  Medical  School 
with  The  Mayo  Foundation 


Digitized  by  the  Internet  Archive 
in  2017  with  funding  from 

University  of  Illinois  Urbana-Champaign  Alternates 


https://archive.org/details/medicalschoolofuOOford 


THE  MEDICAL  SCHOOL  OF  THE  UNIVERSITY  OF  MINNESOTA 
AND  THE  MAYO  FOUNDATION  FOR  THE  PROMOTION 
OF  MEDICAL  EDUCATION  AND  RESEARCH 


FOREWORD 

The  medical  profession  of  the  State  and  the 
alumni  of  the  medical  school  everywhere  will  be 
interested  to  know,  from  authoritative  sources, 
the  nature  and  the  terms  of  the  proposals  which 
have  been  framed  and  submitted  to  the  Board  of 
Regents  for  affiliation  of  the  Mayo  Foundation 
with  the  Medical  School  of  the  University  of 
Minnesota. 

The  profession  at  large  should  be  inter- 
ested in  an  event  big  with  possibilities  for  the 
future  of  medical  education  in  this  State. 

Not  alone  the  theories,  but  the  conditions  of 
medical  education  in  Minnesota,  bearing  upon 
this  question,  should  be  understood.  The  advan- 
tages of  affiliation  should  be  appraised.  The  ob- 
jections to  it  should  be  carefully  weighed  and  its 
net  values  determined. 

With  these  objects  in  view,  this  statement  is 
offered.  Carefully  reviewed  by  representatives 
of  both  parties  to  the  proposed  arrangement,  it 
issues  with  authority. 

It  presents  (a)  the  plan  of  relations  during 
the  proposed  experimental  period  of  affiliation ; 
(b)  the  main  outlines  of  the  ultimate  plan  to 
which  temporary  affiliation,  if  successful,  may 
lead. 

MEDICAL  EDUCATION  IN  MINNESOTA 

In  the  unification  of  medical  education  Minne- 
sota has  accomplished  much.  In  its  control  by 
the  State  University,  the  standards  of  prepara- 
tion for  the  practice  of  medicine  are  assured.  By 
its  ready  adoption  of  educational  advances, 
through  a quarter  of  a century  of  progress ; by 
the  generous  equipment  of  its  scientific  labora- 
tories ; by  the  attainment  of  a teaching  hospital 
providing,  in  part,  for  its  major  clinics;  by  the 
upbuilding  of  a large  and  efficient  outpatient 
service,  the  University  Medical  School  has  placed 
itself  in  the  forefront  of  teaching  institutions. 

The  acquirement  of  rank,  like  the  inheritance 
of  privilege,  imposes  the  principle  of  noblesse 


oblige.  The  State  is  committed  to  the  nearest 
and  the  speediest  approach  it  may  make  to  the 
highest  ideals  of  medical  education.  It  has  ac- 
cepted the  obligation  of  medical  research  in  the 
service  of  the  people. 

In  all  State  institutions,  development  is  con- 
tingent upon  adequate  appropriation.  In  a young 
commonwealth,  of  rapid  growth  and  diversified 
interests,  the  demand  for  the  means  of  support 
is  imperative  in  every  field  of  education.  The 
medical  school  has  received  its  share,  but  that 
share  has  been  inadequate  to  the  supply  of  its 
multiplying  needs.  It  has  called  to  its  aid  the 
public  hospitals  of  the  Twin  Cities  and  with 
helpful  response.  Yet  with  a taste  of  the  teach- 
ing values  of  hospital  beds  all  its  own,  it  finds 
the  quasi-control  of  other  service  unsatisfactory. 
It  now  requires  an  additional  pavilion  of  one  hun- 
dred and  fifty  beds,  a home  for  the  School  for 
Nurses  and  suitable  quarters  for  its  outpatient 
dispensary.  Finally,  it  needs  room,  on  the  new 
campus,  to  house  the  one  badly  dislocated  branch 
of  its  service, — the  department  of  pathology,  bac- 
teriology and  public  health.  Doubtless  it  will 
have  to  accept  the  fulfillment  of  these  needs  by 
piecemeal  and  with  as  much  grace  of  patience  as 
its  faculty  can  muster.  It  does  not  possess  today 
the  full  requirements  of  effective  undergraduate 
training,  to  say  nothing  of  the  needs  of  graduate 
teaching.  Its  perennial  cry  is  : “More  beds  !” 

At  the  present  moment,  a new  problem, — a 
new  opportunity  of  service  awaits  it. 

THE  PROBLEM  OF  GRADUATE  MEDICAL  TEACHING 

The  need  in  America  of  the  Graduate  School 
in  Medicine  is  apparent.  It  is  a need  not  yet 
formulated  as  to  type ; a need  which  finds  in- 
dividual expression  and  must  be  individually  met. 
Methods  of  meeting  it  are  engaging  the  minds  of 
medical  educators  both  east  and  west. 

The  practical  closure  of  the  field  of  graduate 
study  abroad  has  accentuated  the  desire  for  do- 
mestic opportunity ; has  stimulated  teachers'  and 


instructors  to  provide  it.  Men  of  medicine  in 
America  have  long  felt  that  the  pilgrimage  of 
medical  graduates  to  European  clinics  is,  in  large 
degree,  a tradition.  They  have  long  held  that 
the  mechanism  and  material  of  research  may  be 
found  within  our  own  medical  doors.  The  clini- 
cal Mecca  across  seas  has  always  been  sought  by 
many  men  of  merit,  and  by  more  men  of  means. 
Too  often  the  fruitful  student  has  been  barred  of 
his  full  fruition  by  stay-at-home  demands  for  his 
daily  bread.  With  a modicum  of  relief  from 
financial  pressure,  with  a nearby  chance  of  study, 
he  is  ready  to  grasp  eagerly  the  offer  of  grad- 
uate teaching. 

The  tendency  to  specialism  in  medicine  creates 
the  objective  of  the  great  majority  who  go  to 
the  clinics  of  Europe;  but  for  one  who  seeks  his 
goal  through  patient  years  of  preparation  in  the 
schools,  the  many  among  specialists  break  into 
full  bloom  during  a summer’s  junket  to  the  Old 
World.  To  medical  educators  of  today,  this 
forcing  method  no  longer  appeals.  The  argu- 
ment of  fitness  is  gaining  in  the  moral  sense  of 
men,  and  in  the  fit  training  of  specialists  Uni- 
versity schools  recognize  one  of  the  great  needs 
of  the  hour  and,  therefore,  one  of  the  chief  ends 
of  graduate  medical  teaching. 

Willing  students  wait  the  opportunity ; but 
other  things,  also,  are  needed  for  the  develop- 
ment of  the  Graduate  School  in  Medicine.  The 
task  calls  for  men ; for  men  of  large  vision  as 
graduate  teachers,  for  men  who  can  evolve 
method  and  material  other  than  that  which  serves 
the  purposes  of  undergraduate  instruction ; men, 
who,  foregoing  the  ways  and  works  of  the  poly- 
clinic,— the  historic  vaudeville  of  so-called  grad- 
uate study, — can  lead  the  graduate  student  up  to 
larger  conceptions  of  advanced  scientific  medi- 
cine ; men  who  can  cultivate  in  others  the  desire 
to  lay  broad  and  deep  the  foundations  of  really 
specialized  function  in  the  practice  of  the  pro- 
fession, who  can  inspire  in  their  fellows  the  pas- 
sion for  research  and  the  habit  of  following  in 
the  footsteps  of  scientific  truth,  wherever  they 
may  lead. 

There  is  needed,  too,  a wealth  alike  of  clinical 
and  laboratory  material, — a wealth  which  the  or- 
dinary medical  school,  even  of  University  parent- 
age, does  not  possess ; which,  often,  indeed,  it 
does  not  enjoy  to  the  full  measure  of  its  under- 
graduate demands.  Graduate  teaching  in  experi- 
mental medicine  or  surgery,  or  in  the  specialties 
of  practice,  must  be  built  upon  a broad  basis  of 
4afeuratory  study  in  each  relational  field,  while  its 


special  clinical  problems  must  be  made  continually 
the  subject  of  laboratory  investigation.  Large 
must  be  the  mass  of  available  material  from 
which  the  adequate  selection  of  norms  and  of 
aberrants,  for  the  uses  of  the  specialist  in  study, 
may  be  drawn. 

The  appreciation  of  these  great  essentials  of 
graduate  medical  teaching  has  made  the  approach 
of  teachers  to  its  problems  very  slow.  It  should 
no  longer  bar  them  where  means  and  men  and 
material  are  to  be  found. 

THE  GRADUATE  SCHOOL  IN  MEDICINE  OF  THE  UNI- 
VERSITY OF  MINNESOTA 

With  the  authority  of  the  Board  of  Regents, 
the  Administrative  Board  of  the  Medical  School 
has  launched,  within  the  past  year,  the  Graduate 
School  in  Medicine.  Realizing  that  the  definition 
of  graduate  work  must  be  clear,  that  a distinct 
line  of  demarcation  must  be*drawn  between  it  and 
the  practitioners’  courses  of  the  past,  that  the 
conditions  under  which  it  is  offered  must  accord 
with  academic  traditions,  the  school  has  estab- 
lished itself  as  a branch  of  the  Graduate  School 
proper  of  the  University  of  Minnesota.  It  is 
under  the  joint  direction  of  the  Dean  of  the 
Graduate  School,  the  Dean  of  the  Medical  School, 
and  a committee  of  the  medical  faculty  on  grad- 
uate teaching. 

It  offers  a number  of  distinct  opportunities, 
viz. : 

(a)  The  pursuit  of  special  research  problems, 
under  chosen  supervision,  for  unstated  periods 
of  time. 

(b)  Courses  of  graduate  study  in  the  general 
field  of  medicine,  from  which  selection  of  major 
and  minor  subjects  is  made.  These  courses, 
under  direction  of  the  committee,  include  rela- 
tional studies  along  clinical  lines  and  founda- 
tional studies  in  laboratory  branches.  They  in- 
volve the  preparation  of  a thesis.  They  are  ar- 
ranged in  time  periods  of  two  and  three  years. 
They  lead,  finally,  to  the  degrees  of  Master  of 
Science  and  Doctor  of  Science,  respectively. 

(c)  Teaching  fellowships,  awarded  to  the 
selected  graduate  in  medicine,  who  desires  to 
train  himself  in  a given  specialty.  These  fellow- 
ships, in  limited  number,  are  offered  in  Surgery, 
Internal  Medicine,  Obstetrics,  Pediatrics,  Eye, 
Ear,  Nose  and  Throat  Diseases,  and  Nervous  Dis- 
eases. They  cover  a period  of  three  years  of 
study  and  carry  stipends  of  $500,  $750,  and 
$1,000  for  student  support  in  the  three  succes- 
sive years.  Fellows  devote  themselves  exclu- 
sively to  their  chosen  courses  for  eleven  months 


per  annum.  They  give  one-fourth  of  their  time 
to  teaching  assistance,  within  their  specialty. 
One-fourth  of  the  entire  period  is  devoted  to  re- 
lated laboratory  studies.  Major  and  minor  sub- 
jects are  chosen  and  a thesis,  upon  some  ap- 
proved problem  within  the  scope  of  the  major,  is 
required.  These  courses  lead  to  the  degree  of 
Doctor  of  Science,  qualified  by  the  special  sub- 
ject pursued. 

(d)  Graduate  scholarships,  awarded  for  pe- 
riods of  two  or  three  years,  to  the  selected  grad- 
uate in  medicine,  who  wishes,  similarly,  to  pre- 
pare for  the  practice  of  a given  specialty.  These 
scholarships  do  not  carry  any  stipend,  but  are 
exempted  from  payment  of  tuition  fees.  They 
require  the  devotion  of  only  a minor  measure  of 
time  to  assistant  teaching  and  cover  only  nine 
months  in  each  year.  The  requirements  of  these 
scholarships  are  otherwise  identical  with  those 
governing  the  teaching  fellowships,  excepting 
that  two  years  of  successful  study  may  lead  to 
the  degree  of  Master  of  Science,  while  the  three 
year  period  leads  to  the  Doctorate  in  Science. 

Six  teaching  fellowships  and  five  graduate 
scholarships  have  been  provided  for  the  present 
year.  Several  of  these  are  already  filled  and  the 
number  of  applicants  has  been  surprisingly  great. 
These  positions  will  be  increased  as  means  of 
support  can  be  found. 

The  opportunity  of  graduate  teaching  appears 
to  be  limited  only  by  the  capacity  of  clinics  and 
laboratories  to.  provide  suitably  for  the  needs  of 
students.  Every  effective  means  of  increasing 
this  capacity  is  to  be  sought.  Experience  has 
proved  the  unfitness  of  public  hospitals  for  pur- 
poses of  graduate  study.  The  graduate’s  work 
must  be  done  where  clinical  and  laboratory  facil- 
ities are  definitely  controlled  and  freely  granted. 

THE  MAYO  FOUNDATION  FOR  THE  PROMOTION  OF 
MEDICAL  EDUCATION  AND  RESEARCH 

The  large  volume  of  clinical  and  laboratory 
material  gathered  in  the  Mayo  Clinic  at  Roch- 
ester, Minnesota,  suggested  to  its  staff,  some  ten 
years  ago,  the  idea  of  placing  it  within  reach  of 
graduate  students  in  medicine.  Large  success  in 
any  professional  calling  always  awakens  in  men 
the  instinct  of  professional  parentage.  It  has 
awakened  to  a new  and  a notable  departure  in 
this  professional  group. 

For  a time,  the  opportunity  of  graduate  study 
was  informally  extended  to  a few  men  who  de- 
sired to  remain  in  residence  at  Rochester  for  that 
purpose.  Some  five  years  ago,  nine  graduate  fel- 


lowships were  created  by  the  clinic,  under  annual 
and  progressively  increasing  support  stipends  for 
each  of  a succession  of  three  years.  As  the 
laboratory  and  clinical  facilities  for  research  have 
grown,  this  number  of  fellowships  has  been  stead- 
ily increased  until,  at  the  present  time,  thirty-six 
graduate  students  have  been  appointed  and  are 
actively  pursuing  their  studies.  Already  ninety- 
five  men  owe  a graduate  allegiance,  as  untitled 
alumni,  to  the  Mayo  Clinic. 

Its  staff  has  long  recognized  the  desirability  of 
placing  this  graduate  work,  with  the  large  edu- 
cational and  scientific  resources  at  its  command, 
under  University  control ; and  very  recently,  im- 
portant steps  have  been  taken  to  organize  these 
opportunities  and  to  effect  this  relationship.  To 
secure  the  most  nearly  ideal  conditions  for  its 
fulfillment,  it  has  seemed  desirable  to  create  a 
permanent  mechanism  which,  while  utilizing  the 
educational  and  scientific  values  the  clinic  affords, 
can  be  held  distinct  from  the  Mayo  Clinic  as  a 
professional  enterprise. 

At  the  suggestion,  indeed,  of  representatives 
of  the  University,  the  Mayo  Foundation  for  the 
Promotion  of  Medical  Education  and  Research 
has  been  created  and  incorporated.  An  endow- 
ment fund  has  been  provided  by  its  founders. 
This  fund  now  amounts  to  over  $1,500,000  and 
is  to  be  further  increased  in  principal  and  by 
accumulating  interest  from  year  to  year.  It  has 
been  placed,  temporarily,  in  the  hands  of  an  in- 
dependent board  of  trustees.  It  should  be  noted 
that  this  endowment  fund  is  already  removed 
from  the  hands  of  the  Founders  and  has  been 
conveyed  under  a trust  agreement  which  specifies 
the  purposes  for  which  it  is  to  be  used  and  the 
ultimate  disposition  to  be  made  of  it.  It  cannot 
be  employed  for  the  support  of  the  clinic.  It  is 
specifically  devoted  to  medical  education  and  re- 
search. For  the  present,  an  annual  budget  is 
provided  for  the  support  of  the  Mayo  Founda- 
tion. So  long  as  the  foundation  remains  inde- 
pendent, this  budget  will  be  expended  and  the 
educational  and  research  work  of  the  Foundation 
will  be  conducted  by  a chosen  Board  of  Scientific 
Directors.  The  available  clinical  and  laboratory 
material  of  the  clinic  is  placed  at  the  disposal  of 
the  Foundation  for  scientific  uses. 

The  problem  which  is  now  pressing  for  solu- 
tion in  the  minds  of  medical  educators  in  Min- 
nesota is  this : Shall  the  unity  of  medical  edu- 
cation in  the  State  be  preserved  and  strengthened 
by  affiliation  with  this  new  field  of  teaching  and 
research?  Shall  the  scientific  opportunities  of 


the  Mayo  Foundation  be  cultivated  and  standard- 
ized under  the  control  of  the  University?  Shall 
they  be  directed  and  applied  to  educational  uses 
from  the  University  base?  Or,  shall  two  distinct 
and  independent  centers  of  medical  education  and 
research  exist,  instead,  in  the  State  of  Minne- 
sota? 

For  the  Mayo  Foundation,  as  a seat  of  grad- 
uate teaching  and  research,  has  been  established. 
Affiliated  with  the  medical  school  or  not,  it  will 
go  on  in  the  good  work  it  has  begun.  Its  values 
in  men  and  in  material  for  educative  purposes 
will  not  be  permitted  to  go  to  waste. 

The  Proposals  for  Affiliation  Between  the 

Medical  School  of  the  University  of  Min- 
nesota and  the  Mayo  Foundation  for  the 

Promotion  of  Medical  Education  and  Re- 
search 

THE  PROPOSED  PLAN  OF  AFFILIATION  FOR  AN 
EXPERIMENTAL  PERIOD 

Negotiations  for  affiliation  between  the  Medi- 
cal School  of  the  University  of  Minnesota  and 
the  Mayo  Foundation  for  the  Promotion  of  Medi- 
cal Education  and  Research  were  initiated  by 
Dean  E.  P.  Lyon,  at  a meeting  of  the  Adminis- 
trative Board  of  the  Medical  School  on  October 
8,  1914.  A committee,  consisting  of  the  Presi- 
dent of  the  University,  the  Dean,  and  the  Secre- 
tary of  the  Medical  School,  and  two  other  mem- 
bers of  the  Administrative  Board  was  appointed. 

This  committee  has  acted  conjointly  with  a 
committee  of  the  Mayo  Foundation  and  pro- 
posals have  been  formulated  for  an  experimental 
period  of  affiliation  between  the  two  institutions. 
The  terms  of  these  proposals  are  as  follows : 

a.  The  Scientific  Directors  of  the  Mayo  Foun- 
dation are  to  be  nominated  to  and  approved  by 
the  Administrative  Board  of  the  Medical  School 
and,  upon  such  approval,  are  to  be  appointed  by 
the  Board  of  Regents  of  the  University  of  Min- 
nesota. 

b.  The  members  of  the  staff  of  the  Mayo 
Foundation  are  to  be  nominated  by  the  Directors 
and  approved  by  the  Administrative  Board  of 
the  Medical  School. 

c.  The  experimental  period  of  affiliation  pro- 
posed may  be  terminated  at  any  time  upon  one 
year’s  notice  by  either  party  and  upon  the  ful- 
fillment of  existing  obligations  to  the  student 
body. 

d.  The  purposes  of  the  affiliation  are  to  be : 

1.  The  joint  conduct  of  graduate  work.  It  is 
stipulated  that  all  graduate  students,  working  in 


either  institution,  are  to  be  matriculated  and  reg- 
istered at  the  University  under  the  rules  of  the 
^Graduate  School ; that  all  students’  fees  are  to  be 
paid  to  the  University ; that  no  charges  upon  the 
University  are  to  be  made  for  any  work  done  in 
or  by  the  Mayo  Foundation ; that  details  of 
graduate  work,  in  general,  and  of  each  individual 
student’s  work,  in  particular,  are  to  be  arranged 
by  joint  committee;  that  credit  for  work  at  the 
University  or  at  the  Mayo  Foundation  is  to  be 
given  by  the  University.  It  will  be  provided  that 
all  students  receiving  University  credit  shall 
spend  a certain  prescribed  portion  of  time  in 
residence  at  the  University. 

2.  The  interchange  of  graduate  scholars  and 
fellows ; the  details  of  such  interchanges  and  the 
regulations  governing  them,  in  point  of  time  to 
be  spent  and  of  work  to  be  done  by  these  scholars 
or  fellows,  at  either  the  University  or  at  the 
Mayo  Foundation,  to  be  determined  by  joint  com- 
mittee. 

3.  The  interchange  of  workers,  in  assistant- 
ships,  special  lectureships,  direction  of  laboratory 
work,  conduct  of  elective  courses  and  pursuit  of 
research,  in  either  field,  as  between  the  faculty 
of  the  Medical  School  and  the  members  of  the 
staff  of  the  Mayo  Foundation ; the  details  of  such 
interchange  to  be  arranged  by  joint  committee. 

e.  It  is  further  provided : 

1.  That  courses  of  graduate  instruction  in  the 
affiliated  institutions  and  the  teachers  conducting 
them,  shall  be  approved  by  the  committee  of  the 
Medical  School  on  Graduate  Teaching  and  by  the 
Dean  of  the  Graduate  School,  and  that  the  con- 
ferring of  degrees,  to  which  such  work  contrib- 
utes, is  to  be  recommended  by  the  Graduate 
School  to  the  Board  of  Regents  of  the  Univer- 
sity of  Minnesota ; and 

2.  That  the  Committee  of  the  Medical  School 
on  Graduate  Teaching  be  authorized  to  act  con- 
jointly with  a Committee  of  the  Mayo  Founda- 
tion in  arranging  details  of  the  above  plan. 

Such  an  experimental  period  of  affiliation  has 
been  approved  by  vote  of  the  General  Faculty. 
The  specific  proposals,  outlined  above,  have  been 
approved  by  the  Administrative  Board  of  the 
Medical  School  and  have  been  accepted  by  the 
Mayo  Foundation.  They  have  been  submitted  to 
the  Board  of  Regents  of  the  University  of  Min- 
nesota for  consideration  and  final  action. 

THE  TENTATIVE  PROPOSALS  FOR  PERMANENT 
AFFILIATION 

Emphasis  should  be  put  upon  the  fact  that  the 
sole  issue  now  under  discussion  is  that  of  tern- 


porary  affiliation  and  that  the  plan  of  permanent 
relationship  has  not  been  finally  approved. 
These  proposals  are  essentially  tentative. 

The  endowment  fund  is  to  remain  untouched, 
is  to  be  increased  annually  in  principal  and  by 
accrued  interest,  during  the  experimental  period 
of  affiliation.  Should  this  experimental  period  be 
undertaken  and  prove  successful,  the  Founders  of 
the  Mayo  Foundation  have  already  provided  that, 
with  the  approval  of  the  University,  the  present 
Trustees  in  charge  of  the  endowment  fund  shall 
surrender  it,  for  entire  control,  in  investment  and 
expenditure,  alike,  under  the  purposes  declared 
in  the  gift,  to  the  Board  of  Regents  of  the  Uni- 
versity of  Minnesota.  No  restrictions  are  placed 
upon  the  Regents,  excepting  that  the  educational 
and  research  work  is  to  be  maintained  at  Roch- 
ester in  affiliation  with  and  directed  bv  the  Uni- 
versity. 

It  is  provided  that  should  the  Mayo  Clinic, 
for  which  the  University  will  be  charged  with 
no  responsibility  whatever,  fail  of  self-support  or 
deteriorate  in  the  quality  of  its  work,  and  no 
longer  supply,  for  the  uses  of  the  Foundation, 
sufficient  clinical  and  laboratory  material,  the 
Board  of  Regents  may,  at  its  discretion,  make 
other  arrangements  for  the  continuance  of  the 
Foundation.  Suggestion  of  a subsequent  renewal 
of  relations  with  a possibly  resurrected  clinic  at 
any  time  has  been  discussed,  but  is  not  regarded, 
by  either  party,  as  an  essential  point.  In  all 
other  respects,  the  conditions  of  the  experimental 
period  of  affiliation  are  to  become  those  of  the 
permanent  relation,  subject  to  modification  by 
joint  agreement  when  the  event  is  to  be  accom- 
plished. 

Summarized,  the  proposals  mean : 

a.  The  Mayo  Foundation  is  an  accomplished 
fact.  It  exists  for  the  prosecution  of  medical 
research  and  the  encouragement  of  graduate 
study. 

b.  It  is  endowed  with  an  ample  fund  to  be 
used  for  the  specific  purposes  of  the  Founda- 
tion and  for  nothing  else. 

c.  That  fund  is  irrecoverably  in  the  hands  of 
a Board  of  Trustees  instructed,  if  affiliation  be- 
comes permanent,  to  turn  it  over  to  the  Board 
of  University  Regents.  It  will  belong  to  the 
University. 

d.  The  Foundation,  its  work,  its  workers  and 
its  finances,  will  be  definitely  separate  from  the 
clinic. 

e.  The  Foundation  is  to  be  definitely  con- 
trolled as  to  expenditures,  personnel  of  staff, 


courses  of  instruction  and  credits  by  the  Board  of 
Regents. 

f.  Graduate  students,  directed  by  the  Univer- 
sity, will  do  work  both  at  the  University  and  in 
the  Mayo  Foundation  at  Rochester. 

THE  APPRAISAL  OF  VALUES 

It  is  well  that  the  advantages  which  offer  to 
the  University  Medical  School  in  this  affiliation 
be  carefully  appraised.  Such  a gift  to  medical 
education  and  research  is  so  unusual  and  looms 
so  large  in  its  possibilities  that  one  marvels  that 
its  benefits  should  need  statement.  Nevertheless, 
a State  institution  is  the  one  type  of  beneficiary 
which  has  the  duty  of  examining  carefully  the 
conditions  of  a gift.  The  values  not  only  of  the 
gift  itself,  but  of  the  opportunities  it  opens  up, 
are  cited. 

It  might  seem  enough  to  say  that  with  the 
ultimate  control  of  this  endowment  for  higher 
medical  education  and  research  by  the  Board  of 
University  Regents,  the  whole  tale  of  benefits  to 
flow  from  it  would  be  inclusively  told.  But  this 
event  takes  exception  to  the  mathematical  prin- 
ciple that  the  greater  includes  the  less,  perhaps 
because  the  seemingly  less  is  really  the  larger. 

The  association  of  the  Medical  School  with  a 
body  of  professional  men  who  have  successfully 
applied  economic  principles  to  the  practice  of 
medicine,  who  have  approximated  the  ideals  of 
medical  service,  who  have  achieved  distinctive 
and  effective  methods  of  clinical  investigation, 
has  clearly  apparent  worth. 

The  contribution  to  the  service  of  the  Medical 
School  of  men  of  ability  and  distinction  who  will 
give  their  time  and  energy  to  the  work  of  the 
Foundation  under  the  direction  of  the  Univer- 
sity ; the  devotion  of  an  immense  mass  of  scien- 
tific material  to  the  uses  of  education  and  re- 
search, and  both  without  a dollar  of  expense  to 
the  State,  either  for  buildings  or  maintenance, 
have  a significance  that  does  not  need  emphasis. 

The  immediate  development,  with  a minimum 
of  cost  to  the  University,  of  a Graduate  School  in 
Medicine  which  will  stand  absolutely  alone  in  the 
sphere  of  medical  education  in  America,  as  com- 
passed today,  and  will  set  the  type  of  graduate 
instruction  for  the  country  at  large,  is  an  oppor- 
tunity not  to  be  put  by  and  one  of  which  leading 
medical  educators  throughout  the  country  are 
taking  full  account. 

The  substantial  improvement  and  immediate 
enlargement  of  the  mechanism  of  efficient  train- 
ing of  specialists  in  medicine, — a most  important 


service  to  the  State, — and  again  without  increase 
of  budget,  means  more  to  the  future  of  medical 
education  than  can  be  foretold. 

The  stimulative  influence  of  the  work  of  each 
affiliate  upon  the  other,  by  means  of  the  ready 
exchange  of  teachers  and  workers,  will  be  far 
greater  by  virtue  of  the  distinctive  place  and 
character  of  each  institution  than  were  they  com- 
pletely merged  and  their  individual  identity  lost. 

The  stimulus  to  medical  research  which  must 
come  out  of  the  friendly  rivalry  and  the  mutual 
assistance  of  men  in  the  two  institutions ; the  en- 
larged vision  of  problems  which  should  widen 
with  the  increased  means  of  solving  them,  should 
mean  the  higher  development  alike  of  the  teach- 
ing faculty  and  the  Foundation  staff. 

The  encouragement  that  this  affiliation  would 
afford  to  the  development  of  other  agencies  of 
medical  education  within  the  State,  the  sugges- 
tion it  conveys  of  extra-mural  assistance  to  be 
sought  in  the  service  of  medical  teaching,  should 
not  be  overlooked. 

THE  OBJECTIONS  TO  AFFILIATION 

Doubtless  there  are  objections  to  the  proposed 
affiliation  which  it  is  better  not  to  define ; but, 
indubitably,  there  are  medical  men  and  medical 
educators,  of  lofty  purpose,  who  are  fearful  of 
so  new  and  so  broad  a departure  in  the  history 
of  the  Medical  School. 

That  affiliation  of  the  Medical  School  with  the 
Mayo  Foundation  is  an  improper  thing,  because 
the  latter  will  derive  its  financial  support  and  its 
scientific  material  mainly  from  the  Mayo  Clinic 
and  because  the  clinic  is  a private  enterprise  and 
conducted  for  profit,  appears  to  be  the  crux  of 
opposing  argument  in  the  minds  of  many. 

Could  any  contention  that  the  Mayo  Clinic  is 
ethically,  professionally  or  scientifically  unfit  be 
sustained,  this  argument  might  gain  weight. 
Since  the  ablest  and  most  sincere  opponents  of 
the  plan  hasten  to  lay  a tribute  of  respect  before 
the  men  who  have  founded  the  Mayo  Foundation, 
the  argument  loses  force.  Granted  the  integrity 
of  the  institution,  the  plea  applies  as  properly  to 
every  clinical  teacher  who,  whether  singly  or  in 
association  with  his  fellows,  is,  simultaneously 
with  his  teaching  function,  engaged  in  the  pri- 
vate practice  of  his  profession. 

The  proposition  that  the  Mayo  Foundation  is 
inseparable  from  the  Mayo  Clinic  and  that  in  af- 
filiating with  the  first  the  University  necessarily 
goes  into  partnership  with  a private  professional 
business,  is  destroyed  by  many  a precedent  and 
demands  specific  correction. 


METHOD  OF  SEPARATING  THE  FOUNDATION  FROM 
THE  CLINIC 

A careful  examination  of  the  work  now  con- 
ducted at  Rochester  shows  that  it  is  practicable 
to  separate  the  scientific  and  educational  work 
(which  will  belong  to  the  Foundation)  from  the 
business  of  treating  the  sick  (which  will  belong 
to  the  clinic). 

The  scientific  and  research  work  occupies 
nearly  three  floors  of  the  new  building.  To  these 
floors  patients  do  not  go.  Half  of  the  staff  mem- 
bers never  see  patients.  Some  are  not  even  re- 
motely concerned  with  the  patients  of  the  clinic. 
They  are  full-time  laboratory  research  workers. 
Others  divide  their  time  between  practical  duties 
connected  with  the  clinic  and  investigation. 

The  method  of  dividing  the  foundation  from 
the  clinic  will  be  worked  out  along  these  lines : 
Any  laboratory  devoted  entirely  to  research  and 
teaching  will  be  supported  by  the  Foundation. 
Any  apparatus,  animals,  chemical  supplies,  etc., 
needed  for  these  purposes  will  be  furnished  by 
the  Foundation.  The  salary  of  any  chemist, 
pathologist  or  other  worker  engaged  wholly  in 
teaching  and  research  will  be  paid  by  the  Foun- 
dation. Part  of  the  salary  of  men  giving  part 
of  their  time  to  this  work  may  be  borne  by  the 
Foundation.  Expenses  of  scientific  publication, 
etc.,  may  be  paid  by  the  Foundation.  Fellow- 
ships may  be  supported  by  the  Foundation.  In 
fact,  the  Foundation  may  do  any  of  the  things 
for  the  furtherance  of  medical  education  and 
research  which  would  be  proper  for  it  to  under- 
take if  it  stood  alone,  and  may  do  only  such 
things. 

On  the  other  hand,  all  expense  connected  with 
the  care  and  treatment  of  pay  patients  must  be 
borne  by  the  clinic.  A man  engaged  wholly  in 
this  work  could  not  be  paid  by,  nor  connected 
with  the  Foundation.  A laboratory  used  only 
for  clinical  diagnosis  would  be  supported  by  the 
clinic,  not  by  the  Foundation. 

Thus  we  get  concepts  of  the  Foundation  and 
the  Clinic  standing  as  separate  and  distinct  in- 
stitutions, each  with  a certain  number  of  full- 
time workers  not  engaged  in  the  other  at  all,  and 
with  a certain  number  of  part-time  workers  di- 
vided between  the  two  institutions.  The  Foun- 
dation would  by  lease  or  gift  be  entitled  to  quar- 
ters in  the  clinic  building  and  by  proper  arrange- 
ment have  the  right  to  use  the  clinical  material 
for  purposes  of  research  and  education  to  the 
extent  that  the  clinic  may  deem  wise  and  to  the 
extent  that  the  Foundation  may  desire. 

The  clinical,  part-time  teachers  in  the  Univer- 


sity  Medical  School  send  specimens  from  their 
private  practice  to  the  University  laboratories. 
They  use  their  private  case  histories  in  writing 
articles  which  go  out  in  the  name  of  the  Uni- 
versity. They  make  use  of  University  patholo- 
gists for  making  autopsies  in  private  cases,  and 
the  materials  are  worked  up  in  the  University. 
All  of  these  constitute  analogies  of  the  proper 
separation  of  the  Mayo  Foundation  from  the 
Mayo  Clinic  in  the  same  way  that  the  University 
work  of  part-time  teachers  is  separated  from 
their  private  practice. 

OTHER  FEARS 

That  affiliation  with  the  Mayo  Foundation 
will  serve  to  arrest  the  development  of  an  ade- 
quate clinical  system  at  the  University,  is  the  ex- 
pression of  a fear  which  has  taken  possession  of 
some  who  frankly  say  that  could  this  apprehen- 
sion be  removed  they  would  find  no  other  valid 
objection  to  the  plan.  The  difficulty  is  that, 
while  this  fear  is  believed  by  the  administrative 
officers  of  the  University  and  the  Medical  School 
to  be  without  foundation,  to  be  a mere  ghost 
which  these  men  have  raised,  no  assurance  to  the 
contrary  can,  with  propriety,  be  given.  The  ad- 
ministration cannot  commit  future  Boards  of  Re- 
gents or  future  legislatures  to  any  program  of 
clinical  development. 

It  may  only  be  said  that  this  fear  is  unshared 
by  the  proponents  of  the  plan,  that  it  has  never 
been  shared  by  any  of  them  in  either  institution ; 
and  that,  on  the  contrary,  they  hold  that  the  nat- 
ural stimulus  to  the  growth  of  the  Medical  School 
which  the  affiliation  must  be,  will  insure  the 
speedier  completion  of  the  absolutely  essential 
hospital  laboratory  of  the  clinical  teacher. 

That  the  Mayo  Foundation  would  not  be 
adequately  controlled  by  the  University  and 
would  be  subject  to  the  dictation  of  its  Founders, 
to  the  detriment  of  its  stated  purposes,  is  an  argu- 
ment most  effectively  answered  by  inviting  the 


reader  to  review  the  foregoing  statement  of  the 
terms  of  affiliation.  A fund  of  one  and  a half 
million  dollars  or  more  to  go  under  permanent 
affiliation  and  without  reserve,  save  as  to  the  lo- 
cation of  the  work,  into  the  hands  of  the  Board 
of  University  Regents ; a Board  of  Directors  of 
the  Foundation  approved  by  the  Medical  School 
and  appointed  by  the  Board  of  Regents ; a Foun- 
dation staff  similarly  approved  by  the  Medical 
School ; registration  of  students,  courses  of  in- 
struction and  credits  for  study,  controlled  by  the 
University,  are  the  safeguards  which  the  plan 
details. 

That  the  State  University  should  confine 
its  activities  strictly  to  the  University  campus  is 
a time-honored  and  traditional  view.  It  is  not 
the  view  of  modern  educators.  To  avail  itself 
of  every  fit  agency  of  education  and  research 
throughout  the  State,  by  which  its  effective  force 
may  be  increased,  is  as  much  the  part  of  the  mod- 
ern State  University  as  is  the  prosecution  of 
extension  work  on  a campus  as  wide  as  the  State 
itself. 

AFTERWORD 

After  all,  the  one  real  question  involved  in 
the  project  for  affiliation  of  the  Mayo  Founda- 
tion with  the  Medical  School  is  this : Will  that 
affiliation,  in  substantial  measure,  enable  the  State 
to  achieve  more  quickly,  to  approximate  more 
closely,  to  realize  more  fully  the  highest  ideals  of 
medical  education,  to  the  attainment  of  which, 
as  the  public  parent  of  medical  education  in  the 
State,  it  is  pledged? 

George  Edgar  Vincent, 

Elias  P.  Lyon, 

James  E.  Moore, 

Jennings  C.  Litzenberg, 

Richard  Olding  Beard,  Chairman, 
Committee  upon  the  Relations  of  The 
Medical  School  with  the  Mayo  Foun- 
dation. 


THE  MAYO  FOUNDATION  FROM  THE  STANDPOINT  OF  THE 

GRADUATE  SCHOOL 

By  Guy  Stanton  Ford,  Ph.  D. 

Dean  of  the  Graduate  School 
UNIVERSITY  OF  MINNESOTA 


In  discussing  co-operation  with  the  Mayo 
Foundation  from  the  standpoint  of  the  Graduate 
School,  it  is  at  least  not  difficult  to  keep  in  mind 
the  essential  nature  of  the  problem  which  the  re- 
gents, administrative  officers,  and  faculties  of  the 
University  are  considering.  It  is  an  experiment 
in  training  some  thirty  or  forty  well  prepared 
young  graduates  of  high  grade  medical  schools 
for  careers  as  medical  scientists,  medical  college 
teachers,  or  specialists  in  active  practice.  The 
net  result,  if  the  difficult  work  is  well  done,  is,  in 
all  three  fields,  a needed  social  service.  The  Uni- 
versity has  the  right  and  the  obligation  to  under- 
take it  and,  in  doing  its  part,  to  make  use  of  every 
opportunity  and  means  for  adequate  training  in 
this  relatively  unoccupied  field.  It  cannot  too 
often  be  emphasized  that  what  is  here  contem- 
plated has  nothing  to  do  with  the  old  polyclinic 
idea  of  a graduate  school  of  medicine  where  a 
group  of  busy  city  practitioners  gave  a hurried 
six  weeks’  course  to  practitioners  who  went  home 
with  a certificate  to  frame  and  a debt  to  pay  by 
sending  patients  to  the  city  specialists.  The  plan 
in  contemplation  will  require  of  a selected  group 
that  they  spend  three  years  in  advanced  work, 
meeting  at  the  end  the  most  rigid  tests  possible, 
that  of  showing  their  calibre,  as  investigators,  by 
the  preparation  of  a scientific  contribution  which 
definitely  increases  our  ability  to  cope  with  dis- 
ease. Medical  educators  and  university  adminis- 
trators who  are  assuming  the  responsibility  of 
making  this  exacting  preparation  possible  could 
have  but  one  possible  fear  and  that  is, — not  that 
there  might  be  too  much  material,  too  many 
qualified  instructors,  too  much  financial  support, 
— but  rather  that  in  every  point  there  may  be  too 
little.  In  considering  this  essentially  educational 
problem  all  fears  may  be  reserved  for  our  limita- 
tions and  none  for  our  opportunity  to  diminish 
them  by  co-operation  and  control  of  the  Mayo 
Foundation. 

Since  September,  1914,  the  Graduate  Commit- 
tee of  the  Medical  School,  as  the  responsible  unit 
of  the  Graduate  School,  has  been  directing  the 
work  of  a group  of  a half-dozen  such  graduate 
students  as  I have  described  above.  The  prob- 
lems involved  have  never  been  adequately  worked 
out  in  any  university.  It  is  all  path-breaking 


work.  Only  the  four  essentials  of  all  adequate 
graduate  work  were  clear — only  well  prepared 
students  should  be  encouraged,  only  well  trained 
instructors  should  be  in  charge,  adequate  clinical 
facilities  and  material  were  essential  and  the  re- 
sults of  bringing  these  three  factors  together 
should  be  tested  by  the  established  standards  of 
scientific  research.  In  none  of  these  things 
should  undergraduate  standards  prevail.  Where 
a half-dozen  cases  or  operations  might  give  the 
undergraduate  student  the  accepted  treatment,  a 
hundred  might  be  too  few  to  enable  the  graduate 
student  to  strike  out  in  new  paths. 

This  was  the  situation  when,  after  following 
in  a general  way  the  discussions  of  the  medical 
faculty  concerning  co-operation  with  the  Mayo 
Foundation  for  graduate  medical  research  and 
education,  I made  a personal  investigation  of  the 
matter  from  the  standpoint  of  the  Graduate 
School.  If  the  reader  will  recall  the  first  three 
essentials  of  graduate  work  mentioned  above, 
qualified  students,  qualified  instructors,  adequate 
material  and  support,  he  will  have  in  mind  the 
approximate  standards  any  Graduate  School  ad- 
ministrator would  apply. 

My  investigation  was  made  in  the  second  week 
of  January  and  I found  a condition  existing 
which  satisfied  me  upon  all  three  points.  There 
was  in  existence  a well  endowed  teaching  foun- 
dation whose  funds  were  already  sufficient  to 
carry  its  part  of  a teaching  staff  and  laboratory 
equipment,  and  in  addition  give  good  paying  fel- 
lowships to  a group  of  graduate  students.  Of 
the  wealth  of  material  and  equipment  for  such 
students  I should  need  to  make  no  mention,  if 
it  were  not  for  the  fact  that  I am  not  speaking 
of  the  first  floor  of  the  Mayo  Building  primarily,, 
nor  of  the  operating  rooms  at  St.  Mary’s  Hos- 
pital. I found  what  I was  looking  for  in  the  lab- 
oratories, museum  and  library  of  the  upper  floors, 
and  in  the  countless  case  records  in  the  basement 
of  the  Mayo  Building.  The  richness  of  this  ma- 
terial, not  seen  by  the  casual  visitor,  furnishes 
opportunities  for  graduate  medical  work  in  cer- 
tain lines  such  as  can  be  found  nowhere  else  on 
this  continent,  nor  probably  in  the  world.  I 
found  a research  and  teaching  staff,  available 
and  at  work,  sufficient  to  do  its  full  part  in  an- 


independent  teaching  foundation,  and  most  cer- 
tainly its  part  in  a co-operative  plan  such  as  that 
under  consideration.  Some  of  these  were  doing 
nothing  but  research.  The  only  difference  ob- 
served between  those  who  were  engaged  part 
time  in  clinical  practice  and  our  own  part  time 
staff  was  that  the  private  practice  in  Rochester 
was  conducted  under  the  acid  test  of  observers 
from  all  over  the  world,  and  in  Minneapolis  our 
staff  does  its  teaching  in  one-half  of  the  day  and 
devotes  the  other  half  in  its  own  offices  to  pri- 
vate practice.  Of  the  active  staff  at  Rochester 
about  eighteen  were  graduates  or  former  mem- 
bers of  the  University  Faculty.  This  applies  also 
to  four  of  the  five  educational  directors.  I found 
finally  that  a body  of  about  thirty  graduate  stu- 
dents of  international  character  was  engaged  on 
a three-year  course  and  that  their  preparation 
was  such  that  I should  have  no  hesitancy  in  ad- 
mitting them,  with  one  exception,  to  the  Grad- 
uate School  at  the  University  of  Minnesota  for 
the  work  we  began  last  fall.  As  this  whole 
matter  of  approving  students,  staff,  and  educa- 
tional budget  is  to  be  in  the  hands  of  the  Uni- 
versity authorities  we  should  have  only  ourselves 
to  blame  if  standards  and  conditions  are  not 
maintained.  In  other  words,  there  existed  an  en- 
dowed, well  equipped,  well-manned  research  and 
teaching  institution  needing  only  the  things  we 


could  best  supply  to  make  the  combination  of  the 
Mayo  Foundation  and  the  Medical  School  of  the 
University  a unique  and  at  present  unparalleled 
Graduate  School  of  Medicine. 

There  seemed  to  me,  as  the  result  of  this  visit, 
three  possibilities.  The  Mayo  Foundation 
might  be  left  to  live  its  own  independent  exis- 
tence, it  might  seek  affiliation  with  some  other 
university  outside  the  State,  or,  lastly,  it  might 
become  what  its  generous  founders  desire,  a 
present  ally  and,  ultimately,  a great  and  benefi- 
cent part  of  the  University  of  that  State  where 
those  founders  were  born  and  have  spent  their 
lives. 

If  there  be  any  principle  at  the  basis  of  our 
University  as  at  present  organized  which  pre- 
vents it  from  doing  its  great  educational  work 
for  the  State  and  the  nation  and  the  world  by 
taking  advantage  of  this  and  similar  opportu- 
nities when  they  shall  arise  in  agriculture,  arts, 
engineering  or  medicine,  then  let  us  rebuild  on 
principles  that  will  enable  us  to  fit  our  function. 

It  seems  fairly  easy  to  understand,  I hope,  why 
anyone  interested  in  the  development  of  grad- 
uate work  would  rather  face  the  present  fears  of 
the  few  than  have  the  next  generation  point  out 
his  folly  in  not  having  favored  at  least,  an  ex- 
perimental period  of  co-operation  with  the  Mayo 
Foundation. 


HISTORY  OF  NEGOTIATIONS  BETWEEN  THE  MEDICAL 
SCHOOL  AND  THE  MAYO  FOUNDATION 


The  question  of  establishing  relations,  for  edu- 
cational and  scientific  work,  between  the  Minne- 
sota Medical  School  and  the  Mayo  Clinic,  at 
Rochester,  has  been  discussed,  informally,  for  a 
long  time. 

Upon  October  8th,  1914,  the  Dean  of  the  Medi- 
cal School  proposed  to  the  Administrative  Board 
of  the  Medical  School  that  this  question  of  affilia- 
tion be  considered.  The  Dean  was  instructed  to 
appoint  a committee  to  confer  in  the  matter  with 
the  Advisory  Committee  of  the  Medical  Alumni 
Association  and  with  the  Doctors  Mayo. 

A few  days  later  such  committee,  consisting 
of  the  President  of  the  University,  the  Dean  and 
the  Secretary  of  the  Medical  School,  and  the 
chiefs  of  two  departments,  was  appointed. 

On  November  14th,  1914,  a tentative  confer- 
ence of  the  committee  with  the  Advisory  Com- 
mittee of  the  Medical  Alumni  Association  was 
had. 

At  a regular  meeting  of  the  General  Faculty 


of  the  Medical  School  on  November  19th,  1914, 
the  question  of  affiliation  was  informally  dis- 
cussed. The  Faculty  voted  to  request  the  Admin- 
istrative Board  of  the  Medical  School  to  give 
the  Faculty  an  opportunity  for  the  discussion  of 
any  proposed  plan  before  final  action  should  be 
taken. 

Upon  NQvember  29th,  1914,  an  initial  confer- 
ence between  the  committee  of  the  Medical 
School  and  a committee  representing  the  Mayo 
Clinic  was  held  at  Rochester.  At  this  meeting, 
the  proposal  of  the  creation  of  the  Mayo  Foun- 
dation for  the  Promotion  of  Medical  Education 
and  Research  was  made.  The  following  day  this 
proposal  was  accepted  by  the  Doctors  Mayo. 

Conferences  between  representatives  of  the 
two  committees  have  been  had,  from  time  to  time, 
as  negotiations  have  proceeded. 

On  December  3rd,  1914,  the  committee  of  the 
Medical  School  presented  its  report  to  the  Ad- 
ministrative Board  of  the  School.  Certain 


amendments  of  the  plans  submitted  were  pro- 
posed. The  committee  was  instructed  to  con- 
tinue negotiations,  to  submit  these  amendments 
to  the  Doctors  Mayo,  and  to  prepare  a further 
report.  The  amendments  were  so  submitted  and, 
in  the  main,  accepted. 

On  December  16th,  1914,  the  Administrative 
Board  of  the  Medical  School  met  and  received 
a revised  report,  which  was  fully  discussed.  The 
general  principle  of  the  affiliation  was  approved 
by  vote.  The  committee  was  instructed  to  sub- 
mit the  proposals  for  discussion  to  the  advisory 
committee  of  the  Alumni  Association  and  to  the 
General  Faculty. 

On  January  19th,  1915,  a second  conference 
with  the  Advisory  Committee  of  the  Medical 
Alumni  Association  was  held. 

Following  this  conference,  the  officials  of  the 
School  received  from  the  Alumni  Committee  the 
following  resolution : 

“Doubting  the  wisdom  of  the  general  prin- 
ciple of  affiliation  between  the  University  and 
any  private  institution,  we,  the  Advisory  Com- 
mittee of  the  Alumni  Association  of  the  Medical 
School,  approve  of  a temporary  arrangement  be- 
tween the  University  of  Minnesota  and  the  Mayo 
Foundation  to  accomplish  the  following  purposes 
only : 

a.  The  interchange  of  opportunity  for  grad- 
uate study. 

b.  Opportunity  for  interchange  of  members 
of  the  teaching  staffs.” 

On  January  21st,  1915,  a meeting  of  the  Gen- 
eral Faculty  was  called.  Copies  of  proposals 
were  placed  in  the  hands  of  the  members.  A 
full  discussion  followed.  It  was  voted  to  adjourn 
consideration  and  to  postpone  vote  for  two  weeks. 

A second  meeting  was  held  February  5th,  1915, 
and  the  proposals  were  again  discussed  at  length. 
By  a vote  of  39  to  26,  the  following  resolution 
was  adopted : 

“Resolved,  That  this  Faculty  recommends  to 
the  Administrative  Board  the  establishment  of 
affiliation  in  graduate  teaching  and  in  exchange 
of  workers  with  the  Mayo  Foundation,  for  a 
trial  period,  terminable  on  one  year’s  notice  by 
either  party  and  upon  the  fulfillment  of  exist- 
ing obligations  to  students,  under  educational 
conditions  approved  by  the  University.” 

On  February  8th,  1915,  the  Administrative 
Board  of  the  Medical  School  met.  The  pro- 
posed experimental  period  of  affiliation  with 
the  Mayo  Foundation  was  approved  by  a vote 
of  nine  to  one.  The  committee  was  instructed 
to  prepare  resolutions,  covering  this  action ; to 
submit  copies  to  members  of  the  Board  for  com- 


ment and  to  present  the  same  to  the  Board  of 
Regents. 

Upon  February  18th*  1915,  resolutions  pre- 
pared, in  accordance  with  the  foregoing  instruc- 
tions, were  transmitted  to  the  President  for  pres- 
entation to  the  Board. 

On  March  4th,  1915,  the  above  resolutions 
were  reported  to  the  regular  meeting  of  the 
Administrative  Board  and  two  minor  changes 
were  suggested.  As  so  revised,  the  resolutions 
were  finally  approved,  the  secretary  was  in- 
structed to  record  them,  to  furnish  a copy  to  each 
member  of  the  Board,  and  to  re-submit  final  revi- 
sion to  the  President. 

On  March  6th,  1915,  such  revised  resolutions 
were  transmitted  to  the  President.  They  read 
as  follows : 

RESOLUTIONS 

Whereas : An  institution  known  as  the  Mayo 
Foundation  for  the  Promotion  of  Medical  Educa- 
tion and  Research  has  been  incorporated,  in 
which  educational  and  scientific  work  in  medicine 
is  being  and  will  be  done ; and 

Whereas : Certain  proposals  for  an  experi- 
mental period  of  affiliation  between  the  Medical 
School  and  the  Mayo  Foundation  have  been 
formulated  and  considered;  and 

Whereas:  It  is  understood  (a)  that  the  Mayo 
Foundation  is  to  be  supported  during  the  pro- 
posed experimental  period  of  affiliation  by  an 
annual  budget  to  be  provided  by  the  Founders ; 
(b)  that  this  budget  is  to  be  expended  by  a 
Board  of  Directors,  which  will  also  be  charged 
with  the  supervision  of  the  educational  and  scien- 
tific work  of  the  Foundation;  (c)  that  this  Board 
of  Scientific  Directors  is  to  consist  of  six  physi- 
cians or  medical  scientists,  five  of  whom  are  to 
be  nominated  by  the  Founders  and  one  by  the 
Medical  School,  all  of  whom  are  to  be  submitted 
for  approval  to  the  Administrative  Board  of  the 
Medical  School  and,  upon  such  approval,  are 
to  be  submitted  for  confirmation  to  the  Board  of 
Regents  of  the  University  of  Minnesota ; and 
(d)  that  the  teaching  and  scientific  work  of  the 
Foundation  is  to  be  conducted  by  a staff,  the 
members  of  which  are  to  be  nominated  by  the 
Board  of  Directors  of  the  Foundation  and  are 
to  be  submitted  for  approval  to  the  Adminis- 
trative Board  of  the  Medical  School. 

Resolved,  That  such  an  affiliation  for  such  an 
experimental  period  be  recommended  to  the 
Board  of  Regents  of  the  University  of  Minne- 
sota, with  the  understanding  that  this  period  of 
affiliation  may  be  terminated  at  any  time  upon 
notice  of  one  year  by  either  party  to  the  affilia- 


tion  and  upon  the  completion  of  existing  obliga- 
tions to  students. 

Resolved,  That  (a)  a reciprocal  relationship 
for  the  conduct  of  graduate  work  be  under- 
taken, with  the  understanding  that  credit  for 
work  in  either  place  is  to  be  given  by  the  Univer- 
sity ; that  registration  of  graduate  students  is 
to  be  made  at  the  University ; that  students’  fees 
are  to  be  paid  to  the  University ; that  no  charges 
are  to  be  made  upon  the  University  for  work 
done  in  or  by  the  Mayo  Foundation ; that  the 
details  of  such  reciprocal  relation  and  of  the 
work  to  be  undertaken  by  graduate  students,  in 
general  and  for  each  individual  student  matricu- 
lated at  either  place,  are  to  be  arranged  by  joint 
committee. 

(b)  That  an  interchange  of  graduate  scholars 
and  fellows  as  between  the  University  and  the 
Mayo  Foundation  be  had ; that  the  details  of  such 
interchanges  and  the  regulations  to  govern  them, 
in  point  of  time  and  of  work  to  be  done  by 
graduate  scholars  or  fellows  in  either  place,  are 
to  be  worked  out  by  joint  committee. 

(c)  That  an  arrangement  of  opportunities  for 
interchange  of  workers,  in  the  way  of  assistant- 
ships,  special  lectureships,  direction  of  laboratory 
work,  conduct  of  elective  courses  and  the  pur- 
suit of  research,  in  either  field,  by  the  Faculty 
or  Foundation  members,  is  to  be  made  and  that 
the  details  of  such  interchanges  of  workers  are 
to  be  arranged  by  joint  committee. 

(d)  That  courses  of  graduate  instruction  con- 
ducted in  the  affiliated  institutions  and  the  teach- 
ers conducting  the  same,  be  under  the  approval 
of  the  Committee  on  Graduate  Teaching  and 
of  the  Dean  of  the  Graduate  School;  and  that 
the  conferring  of  degrees,  to  which  such  work 
contributes,  is  to  be  recommended  by  the  Grad- 
uate School  to  the  Board  of  Regents. 

(e)  That  the  Committee  on  Graduate  Teaching 


of  the  Medical  School,  including  the  dean  of  the 
Graduate  School,  be  authorized  to  act  conjointly 
with  a Committee  of  the  Mayo  Foundation  in 
arranging  the  details  of  the  matters  referred  to 
above. 

THE  CONDUCT  OF  NEGOTIATIONS 

The  bodies  officially  concerned  in  the  conduct 
of  these  negotiations  are : 

a.  The  Administrative  Board  of  the  Medical 
School,  consisting  of  the  President  of  the  Uni- 
versity, the  Dean,  the  Secretary  of  the  Medical 
School,  the  heads  of  all  departments,  and  one 
member  elected  by  the  General  Faculty;  charged 
with  the  legislative  and  administrative  affairs  of 
the  School,  subject  to  the  Board  of  Regents. 

b.  The  Committee  of  the  Administrative 
Board  entrusted  with  actual  negotiations. 

c.  The  General  Faculty  of  the  Medical  School, 
composed  of  all  teachers  of  professorial  rank  and 
of  instructors.  Its  function  is  purely  advisory. 

d.  The  Board  of  Regents  of  the  University  of 
Minnesota,  its  governing  body. 

e.  The  Advisory  Committee  of  the  Medical 
Alumni  Association,  in  this  instance  an  unofficial 
consulting  body,  composed  of  graduates  of  the 
Medical  School. 

f.  The  Mayo  Clinic,  consisting  of  the  Doctors 
William  J.  and  Charles  H.  Mayo,  of  Drs.  Judd, 
Balfour,  and  Plummer,  and  the  staff  of  physi- 
cians associated  with  them.  The  activities  of 
the  clinic,  for  many  years,  have  been  : ( 1 ) , in 
the  conduct  of  medical  and  surgical  practice; 
(2),  in  the  investigation  of  disease;  (3),  in  the 
graduate  teaching  of  medicine  and  surgery. 

g.  The  Mayo  Foundation  for  the  Promotion  of 
Medical  Education  and  Research,  created  in  Nov- 
vember,  1914,  and  since  incorporated,  endowed 
by  a trust  fund  of  $1,500,000,  to  which  is  trans- 
ferred the  activities  of  the  clinic  designated 
under  (2)  and  (3). 


PRECEDENTS  FOR  AFFILIATION 


The  University  of  Minnesota,  through  the 
Agricultural  Department,  is  already  affiliated  with 
the  farming  interests  of  the  State.  It  carries  on 
experiments  with  private  farms,  orchards  and 
herds. 

The  mining  students  are  obliged  to  spend  a 
certain  amount  of  time  in  privately  owned  mines 
on  the  range.  The  Michigan  School  of  Mines  is 
located  at  Houghton,  entirely  for  the  practical 
benefit  to  be  gained  from  the  local  mines.  Other 


mining  schools  have  similar  co-operative  arrange- 
ments. 

Our  forestry  students  do  work  in  various  parts 
of  the  State.  The  University  of  Washington 
Forestry  Department  does  practical  work  in  the 
mills  and  logging  camps  of  the  State.  New  York 
State  maintains  a Forestry  Department  in  con- 
nection with  Syracuse  University,  a private  insti- 
tution. 

The  Medical  School  of  the  University  of  Min- 


nesota,  through  its  Department  of  Pathology  and 
Bacteriology,  does  work  for  physicians  in  private 
practice,  performs  autopsies  and  makes  laboratory 
tests.  The  Department  of  Pharmacology  makes 
special  examinations  for  physicians  and  others. 

Until  recently  the  Medical  School  was  affiliated 
with  various  private  hospitals.  Under  the  new 
elective  curriculum  and  plan  of  graduate  instruc- 
tion there  seems  no  good  reason  why  such  af- 
filiations should  not  be  renewed.  Each  proposi- 
tion should  be  considered  on  its  merits. 

The  University  of  Illinois  and  other  state  uni- 
versities do  a large  part  of  their  medical  teaching 
in  affiliated  private  hospitals. 

Our  Graduate  School  permits  its  students  to  do 
work  for  credit  anywhere  in  the  world  where 
facilities  for  research  exist.  This  is  a general 
rule  of  graduate  schools. 

A committee,  composed  of  leading  clinical 
teachers  of  the  United  States  and  Canada,  was 
appointed  by  the  American  Medical  Association, 
about  a year  ago,  to  consider  plans  for  the  reor- 
ganization of  clinical  teaching  in  medical  schools. 
The  report  of  the  committee,  submitted  by  the 
president  of  the  American  Medical  Association, 
Dr.  Victor  C.  Vaughan,  of  the  University  of 
Michigan,  has  just  been  published.  The  follow- 
ing is  a quotation  from  this  report : “As  many 
extramural  hospitals  as  possible  should  be 
brought  into  affiliation  with  the  medical  schools 
to  provide  for  the  development  of  graduate  work 
which  now  needs  careful  consideration.” 

The  University  of  Cincinnati,  a municipal  in- 
stitution supported  by  taxation,  is  affiliated  with 
many  manufactories  and  building  firms.  The  stu- 
dents of  its  Engineering  School  get  all  their  shop 
practice  in  these  private  commercial  concerns. 

On  the  other  hand,  the  Missouri  Botanical  Gar- 
den, owned  by  the  City  of  St.  Louis,  is  affiliated 
with  Washington  University,  a private  institution. 

The  State  of  Pennsylvania  appropriates  money 
for  various  private  hospitals  in  which  medical 
teaching  is  done. 

The  Massachusetts  Institute  of  Technology,  the 
“Land  Grant  College  of  Mechanic  Arts  of  the 
State,”  receives  state  aid  and  affiliates  in  Public 
Health  teaching  with  Harvard  University,  a non- 
public corporation. 


President  Pritchett  states : “The  device  of  a 
subsidiary  board  in  control  of  a special  department 
of  university  work  is  by  no  means  unusual.  The 
Hooper  Institute  of  Medical  Research  of  the 
University  of  California  is  governed  by  a board 
of  seven  men  appointed  by  the  Regents  of  the 
University.” 

Several  State  Universities  are  affiliated  with  the 
Marine  Biological  Laboratory  located  at  Woods 
Hole,  Mass.  They  pay  for  the  support  of  re- 
search tables  and  send  their  graduate  students 
there. 

The  Marine  Biological  Station  at  San  Diego, 
formerly  independent,  and  affiliated  with  the  Uni- 
versity of  California,  has  recently  been  taken  over 
by  that  University.  It  is  run,  however,  by  a 
“Local  Board.”  This  is  almost  a perfect  prec- 
edent for  the  proposed  temporary  affiliation  with 
the  Mayo  Foundation,  to  be  followed,  if  desired, 
by  permanent  union. 

Animal  Husbandry  students  at  the  University 
of  Ohio  spend  their  first  year  in  residence,  their 
second  on  stock  farms,  their  third  again  in  resi- 
dence, and  their  last  year  on  other  farms.  The 
catalog  says,  “Some  of  the  leading  stockmen  of 
Ohio  and  other  States  have  agreed  to  co-operate 
in  arranging  this  course.” 

The  Wisconsin  catalog  says,  “The  College  of 
Agriculture  has  inaugurated  a movement  for  the 
establishment  of  a system  of  accredited  farms.’’ 
Candidates  for  the  M.  S.  degree  may  gain  one 
semester’s  credit  by  work  on  such  farms. 

Purdue  University,  the  Engineering  College  of 
the  State  of  Indiana,  works  in  close  co-operation 
with  the  electric  and  steam  railways  of  the  State. 
Students  carry  on  tests  and  do  other  work  under 
service  conditions  on  these  privately  owned  rail- 
ways. The  school  is  especially  proud  of  its  courses 
in  locomotive  engineering  on  this  account. 

Finally  may  be  mentioned  the  extensive  plan  of 
affiliation  in  seventh  year  or  interne  work  under- 
taken by  our  Minnesota  Medical  School.  The 
hospital  in  which  a student  takes  his  interneship 
must  be  satisfactory  to  the  school,  i.  e.,  must  give 
him  satisfactory  facilities  and  instruction.  This 
year  of  work  is  required  for  graduation.  The 
school  is  making  this  type  of  affiliation  all  the 
time. 


